An analysis of hospital-treated attempted hanging and drowning in Ireland, 2007-2019

Abstract Background Highly lethal of methods of self-harm, such as attempted hanging and drowning, are a major public health concern due to their high associated risk of completed suicide. This study aims to describe hospital presentations for attempted hanging and drowning in Ireland and explore the factors associated with self-harm and repeat self-harm by these methods. Methods Data on all self-harm presentations to Irish hospitals (2007-2019) were obtained from the National Self-Harm Registry Ireland, a national surveillance system of hospital-treated self-harm. Multivariable logistic regression was used to explore factors associated with any presentation for attempted hanging and drowning and factors associated with repetition of attempted hanging and drowning. Results There were 9,719 and 4,637 attempted hanging and drowning hospital presentations, respectively, in Ireland in 2007-2019. The odds of presentations being due to hanging, rather than due to any other self-harm method, were highest for males (aOR 2.88, 95% CI: 2.76-3.02), children aged <15 (aOR 1.32, 1.17-1.48) and in summer (aOR 1.09, 1.02-1.14). The odds of presentations being due to drowning, rather than due to any other self-harm method, were highest for those aged ≥55 (aOR 1.60, 1.43-1.78), homeless individuals (aOR 2.59, 2.32-2.89) and in autumn (aOR 1.15, 1.06-1.25). Repetition of attempted hanging was positively associated with homelessness (aOR 2.47, 2.02-3.04) and acute alcohol ingestion (aOR 1.12, 1.02-1.23). Similar associations were observed for repetition of attempted drowning. Conclusions This study identifies key population groups for whom the risk of self-harm, or repeat self-harm, by hanging and drowning is greatest. Universal, targeted and indicated interventions are needed to address the determinants of highly lethal methods of self-harm. Biopsychosocial assessments of those presenting after attempted hanging and drowning are essential, in view of their high risk of repeat self-harm and suicide. Key messages Compared with other self-harm methods, the risk of self-harm by hanging and drowning may be highest among males and children aged <15 years and adults aged ≥55 and homeless individuals, respectively. A combination of interventions are needed to address self-harm by highly lethal methods.


Background:
Major depressive disorder (MDD) and alcohol use disorder (AUD) are leading causes of disease burden in Europe, with MDD disproportionately affecting women and AUD being more prevalent among men. However, it is unclear how country-level political and socio-cultural characteristics contribute to gender differences in these conditions. Methods: Data for 30,416 participants from 16 countries were obtained from the 2014 European Social Survey. Depressive symptoms were ascertained using the 8-item CES-D scale, and alcohol use was assessed with items on past-year alcohol use frequency and quantity, as well as frequency of heavy episodic drinking. Country-level data for attitudes to gender equality, needsadjusted public social expenditure, and other covariates came from the 2012 International Social Survey Programme and the OECD. Modified Poisson and linear regression with log link examined additive and multiplicative interactions of countrylevel characteristics with gender for MDD, AUD, and their specific symptoms/dimensions. Results: Public social expenditure was not associated with gender differences in MDD (CES-D>10), but with greater differences in the prevalence of the loneliness and sadness symptoms; support for gender equality was associated with smaller differences in loneliness (p < 0.05). For AUD, there was evidence of increased alcohol use frequency and quantity among women, and decreased frequency and quantity among men associated with support for gender equality, resulting in lower gender differences in predicted probabilities (from 23% to 5% across exposure levels; p < 0.001). Heavy episodic drinking was strongly positively associated with support for gender equality among women (p < 0.001), but not among men.

Conclusions:
Country-level characteristics appear to exert differential impact on the prevalence of AUD and certain psychological symptoms of MDD among men and women in Europe.
Pending replication, future research should examine underlying mechanisms.

Key messages:
Country-level characteristics appear to influence the magnitude of gender differences in prevalent alcohol use disorder and certain psychological symptoms of major depression across Europe. Favourable country-level attitudes towards gender equality appear to be associated with lower overall prevalence of alcohol use disorder, but higher prevalence among women.
Background: Highly lethal of methods of self-harm, such as attempted hanging and drowning, are a major public health concern due to their high associated risk of completed suicide. This study aims to describe hospital presentations for attempted hanging and drowning in Ireland and explore the factors associated with self-harm and repeat self-harm by these methods.

Methods:
Data on all self-harm presentations to Irish hospitals (2007-2019) were obtained from the National Self-Harm Registry Ireland, a national surveillance system of hospital-treated selfharm. Multivariable logistic regression was used to explore factors associated with any presentation for attempted hanging and drowning and factors associated with repetition of attempted hanging and drowning.

Background:
Following the increased internet use due to the COVID-19 pandemic there have been concerns regarding an elevated risk of developing internet addiction (IA). University students are especially prone to develop IA and risk factors for its development in this population during pandemics are not fully investigated nor understood. This study aimed to identify possible risk factors of IA in the studied population during the ongoing pandemic and to compare it with risk factors in prepandemic time.

Methods:
In April 2016 and April 2022 a validated, anonymous questionnaire that contained questions regarding demographic data, as well as Young's Internet Addiction Test, was selfadministered to a cross-faculty representative student sample of the University of Osijek, Croatia.

Results:
The study included 1602 university students median age of 21 years (interquartile range 20-22), 34.5% males, and 65.5% females. There was no statistically significant difference in the median age between the two student samples (p = 0.234). The main reason for internet use (social networking and entertainment and online gaming) was considered the significant risk factor for IA in a studied population in pre-pandemic time (the year 2016) and pandemic time (the year 2022) (p < 0.001).
In pre-pandemic time the IA was more frequent in males (p = 0.046) while the difference in IA prevalence between sexes did not exist during pandemics (p = 0.160). During pandemics, the students who did not work during their study had higher proportions of IA (p = 0.021) while there was no difference in IA prevalence among students regarding their working status during the study in pre-pandemic time (p = 0.251).

Conclusions:
During the COVID-19 pandemic working status of students has been recognized as the new risk factor for IA in the Croatian university students population. Further studies are needed to identify other possible risk factors for IA in the studied population during pandemics.

Key messages:
The COVID-19 pandemic has changed the set of risk factors for IA among Croatian university students. Better understanding of risk factors for IA among university students during the COVID-19 pandemic will enable the development of successful preventive programs for this behavioral addiction.

Background:
Evaluation of preoperative anxiety and health literacy is important for healthcare professionals to understand the needs and expectations of patients and provide them with the necessary support. The study aimed to evaluate the preoperative anxiety levels of patients who applied to the anesthesia outpatient clinic and its relationship with health literacy.

Methods:
A cross-sectional study was conducted on patients who applied to the anesthesia outpatient clinic of Eskişehir Osmangazi University Medical Faculty Hospital in March 2022. The questionnaire form, which was prepared by making use of the literature, was filled in by face-to-face interview method after obtaining the participants' verbal consent. The 6 item Amsterdam Preoperative Anxiety and Information Scale (APAIS) in which the scores that can be taken range from 6 to 30 and higher score means higher anxiety was used to assess the level of anxiety, and the 16 item European Health Literacy Scale Short Form was used to assess health literacy. Descriptive statistics, Chi-Square test and Logistic Regression analysis were used to analyze the data.

Results:
In the study group, 197 (50.3%) were female. Their ages ranged from 18 to 86, with a mean of 45.7 AE 17.2 years. The median (min-max) APAIS score was 15 (6-30). There was a moderate negative correlation between the scores obtained from the APAIS and the European Health Literacy Scale Short Form (r = -0.50, p < 0.01). According to the logistic regression analysis, preoperative anxiety was found to be 1.53 (%95 CI; 1.01-2.30) times higher in women, 3.49 (%95 CI; 1.23-9.94) times higher in those with low family income, and 1.61 (%95 CI; 1.07-2.42) times higher in those with type A personality.

Conclusions:
More than half of the patients had preoperative anxiety. The level of preoperative anxiety decreased as the health literacy level increased.
Key messages: Necessary support should be given for the preoperative anxiety of the patients. Public health policies should be developed in order to increase health literacy.